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Give my knees to the needy.

In the 7th Century BC,[1] a Chinese physician named Bian Que tried transplanting the heart of a strong-willed commoner into the body of a weak-willed emperor.

During the late 19th Century surgeons finally developed the technical ability to conduct operations (knowledge of how the body functioned, anesthesia, antiseptics) and this made transplants possible. However, it took much longer to develop the ability to prevent rejection of the implanted organ by the body’s immune system. Thus, the transplanted “Hands of Dr. Orloc” (1924) weren’t. Lung (1963), liver (1967), and heart (1967-1968) transplants were “successful” in the sense that the patients lived for weeks to months after the operation. In 1970 the development of the immuno-suppressive drug cyclosporine finally permitted successful transplantation to begin. Since 1970 transplants have become common: hearts, lungs, kidneys, livers, pancreases, hands, facial tissue, and bones have all been transplanted. No brains, yet.

The mismatch between donors and recipients.

Generally, there are more sick people in need of an organ than there are dead people with healthy organs for “harvesting.” While the growth of organ transplantation has extended many lives, people often die waiting for an available organ. National medical systems have developed ways of determining who gets priority.

However, there are two issues to bear in mind. First, national boundaries create barriers between donors and recipients. Second, as we have seen in so many other areas, great differences of wealth and income between different parts of the world lets buyers in rich countries get what they want in poor countries. People with money who want to jump the line can seek organ transplants abroad. One outcome of globalization has been to create a market in organs for transplant.

The global trade in organs.

Some Asian countries used to have a legal market in organs: India (until 1994), the Philippines (until 2008), and China (to this day) all allowed the legal sale of organs. Sometimes governments participate in this trade. An estimated 90 percent of the organs from China are taken from criminals executed in prisons. (They used to shoot them in train stations.)

There is also a thriving black-market in organs. The average price paid to a donor for a kidney is $5,000, while the average cost to the recipient is $150,000. When the Indian Ocean tsunami wrecked many fishing villages, about 100 villagers—almost all of them women—sold kidneys. According to one report, 40-50 percent of the people in some Pakistani villages have only one kidney. “It’s a poverty thing. You wouldn’t understand.”

Both the desire to circumvent the laws at home and the need to be close-by when an organ becomes “available” have stimulated “medical tourism.”

Finally, there is the alleged problem of “organ theft.” Given a shortage of voluntary donors, it has been suggested that some middle-men may turn to theft or murder. This is a common theme in horror movies and urban legend. It doesn’t have much truth behind it. Which isn’t the same as saying it doesn’t happen at all. “Hey buddy, can you give me a hand?”

[1] I can just see the Three Wise Men—one of them played by Buscemi—impatiently flipping through the calendar in 1 BC, marking off the days until Jesus would be born, trying to get a cheap flight, then getting told that Bethlehem’s inns are all booked solid: “Zoro-H-Aster! What are we supposed to do, stay in a manger?”